December 20, 2012 2 Comments

An American Problem

It has been hard this week in the wake of the Sandy Hook shootings not to think of children, and of all the ways in which they can be and are hurt. It has also seemed important to think about how we can help, if only by talking to the children we know and checking in with others who have suffered unimaginable losses.

NPR correspondent Linton Weeks, whose two young adult children - ”all our children” – were killed in a car accident, offered this advice about what he and his wife found, and still find, helpful.

But there’s no one answer to the question of how to talk about something so awful, irrevocable, and sad.

In medicine, we often have to deliver bad news and help people during and after horrific losses. We have  articles and videos to help us learn these critical skills, but the results of a small study by the doctor-writer and pediatric hematologist-oncologist Chris Adrian described in a very readable (i.e. not just for doctors) essay in this week’s New England Journal of Medicine illustrate just how complex and challenging it is to learn how to respond helpfully to the distress of others.

Dr. Adrian interviewed the doctors in his division about the psychosocial care of their patients and learned that “the skill of recognizing and addressing patients’ emotional needs was teachable and not teachable; that they’d learned it or never learned it in didactic sessions; that it had been modeled deliberately or accidentally by their superiors, through impeccable habits or disastrous mistakes.”

In other words, what helped one person was often the opposite of what helped another. And what worked in one situation wasn’t necessarily useful in another. And that seems the key lesson: there is no one way to deal with unimaginable tragedy; there are many. We cope as best we can, in whatever ways seem to work at that moment, and as is nearly always the case in life and medicine, there is no one right approach or answer.


Because I have been thinking about children, this week’s FEATURED STORY OF THE WEEK is “An American Problem” about a young Cambodian-American girl whose bedwetting leads to a crisis both in her struggling refugee family and for the health center social worker who tries to help her. This excerpt comes early in the story, but is not the story’s beginning:

…In early August, a moist summer fog hung over the city, retreating to the coast for only a few hours at midday. As a result, Bopha’s sheets and nightshirt, thrown over the fire escape railing each morning, didn’t always dry by bedtime. For three nights in a row, she climbed into a damp bed in the evening and out of a wet one the next day. On the fourth night, she dreamed she fell into a bucket of boiling water and couldn’t get out. She woke screaming, kicking the covers away. Her mother came running and turned on the light to reveal an angry red rash from Bopha’s waist to the middle of her thighs.

There were tears that night, her mother’s not Bopha’s – Bopha never cried – and from her father, lots of yelling. His face turned the dark purple of grape juice, and he used his hands for emphasis, waving them wildly and occasionally aiming his tobacco-stained fingertips at Bopha’s face. While he shouted about bad behavior and wasted money and letting the family down, she compared his bare feet so broad and flat and pale with her own tiny brown toes and high rounded arches. She stood with her legs apart because the air felt good on the burn beneath her nightshirt.

Suddenly, Bopha felt a tight, pinching pain in the upper parts of her arms and the floor pulled away from her feet. Her father lifted her until their faces were nearly level. “Pay attention,” he yelled, his mouth leaking the familiar sour smell of old curry and ashtray bottoms and whiskey. Bopha held her breath until she got a funny feeling in her head that made her eyes want to close.

Across the room, her mother repeated a single word like an incantation. At first, Bopha couldn’t make out what she was saying, and then she recognized it was a name: Vanak. Her father must have heard it too. Without warning, he let go and she fell to her knees. For a second, the apartment was perfectly quiet. Then her father grabbed his coat and left, slamming the door behind him. Immediately, the baby wailed and soon enough, the others joined him. Bopha too felt something hot and hard in her throat like a small animal trying to get out, but she swallowed again and again, until she made it go away…

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2 Responses to An American Problem

  1. Jarod December 29, 2012 at 4:52 pm #

    Your post, An American Problem – Louise Aronson, is really well written and insightful. Glad I found your website, warm regards from Jarod!

    • Louise Aronson December 31, 2012 at 10:08 am #

      Thanks Jarod. It was not at all clear how to address the issue but also clear that it was impossible to address anything else under the circumstances.

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